is called?" I answer, the row is about something more than a mere abstraction, and the difference it makes in many instances involves the issue of life and death. If the position I hold on the subject is correct, the term "chronic dysentery" in the great majority of cases is a misnomer; whether the position be correct or not, the name is worse than misleading. The time-honored teachings in regard to the treatment of acute dysentery uniformly endorse medication by mouth, and the same idea obtains almost as uniformly as to the management of the so-called chronic form. The very name, dysentery, which the patient is usually ready to suggest for his malady, seems capable only of the routine therapeutic translation, bismuth, opiates, and astringents. It would utterly astonish the members of this learned body if I should give the treatment which I have known to be employed in some of these cases. Heretofore I have expressed the conviction and I make bold to reiterate it in this connection, that in this fair Southland of ours many a sufferer has found everlasting peace as the result of a physician's misguided efforts not to mention others who exist in living death, slaves to the opium habit.

My purpose in this brief paper, Mr. President and gentlemen, has been simply to lay before you my personal views as to the real nature of this so-called "chronic dysentery," and to beg that the term be dropped from our vocabulary. To summarize, the points I would especially emphasize are:

First, that almost without exception the condition so named is purely local.

Second, that the term "chronic dysentery chronic dysentery" as ordinarily employed does not and can not refer to a definite pathologic entity, but rather covers a wide variety of local diseases in no way related to dysentery.

Third, that a chronic discharge from the bowel unattended by the well recognized symptoms of a general systemic disease process, always indicates a lesion of the rectum, sigmoid, or colon; and

Fourth, that the idea of a necessary relation between bloody discharges and chronic dysentery is based upon a false assumption and should be both abandoned and forgotten.

In order that we may know the truth with reference to these

cases, the one thing needful is that every patient who consults us for such trouble be, without exception, subjected to careful physical examination. In the name of humanity and for the honor of the great profession to which we belong, let us not be content with conjecture where we may have knowledge, with failure where we should have success.

Abstracts.

THE TREATMENT OF SEROUS EFFUSIONS. *

The author describes what is evidently a new method of treating serous effusions. The idea occurred to him to inject one fluidrachm of Adrenalin Chloride Solution into the pleural sac, in a case of abdominal cancer extending to the pleura, after the aspiration of a large quantity of bloody serum, the object of the injection being to lessen the secretion. There was no further secretion, consequently no further tapping and the patient spent the remainder of her life in perfect comfort so far as her chest was concerned.

This treatment was extended to cases of ascites due to hepatic cirrhosis in which marked results were not expected. However, the quantity of the Adrenalin Solution used varying from two to three fluidrachms.

In a case of pericarditis with effusion in a lad, nineteen fluidounces of serum was withdrawn from the pericardium, but a reaccumulation rapidly followed. The patient's condition becoming critical, the paracentesis was repeated, twenty ounces of fluid being withdrawn with immediate improvement in the quality of the pulse. Forty minims of Solution Adrenalin Chloride, 1-1000, was injected into the pericardium. The pulse at the wrist disappeared, the boy became of an ashy leaden hue and had an anxious expression. Immediately nitroglycerin and atropin were administered and the boy quickly rallied. No fur

* Abstract of a Clinical Lecture delivered at the Liverpool Royal Infirmary, by James Barr, M. D., F. R. C.. P (The British Medical Journal, March 19, 1904.)

ther tapping was required. The same patient had a subsequent attack of left pleurisy with effusion. Ten fluid-ounces of serum was withdrawn from the chest and one fluidrachm of Adrenalin Chloride Solution was injected. There was no reaccumulation.

In a case of tuberculous peritonitis and ascites two hundred fluid-ounces of serum was withdrawn and two fluidrachms of Solution Adrenalin Chloride introduced into the peritoneal cavity, with four pints of aseptic air (to prevent adhesions). Thirteen days later 237 fluid-ounces of serum was withdrawn and two fluidrachms of Adrenalin Chloride Solution and two pints of air were injected. Upon a third occasion, eleven days later, 196 fluid-ounces of serum was obtained by tapping, and three fluidrachms of Adrenalin Chloride Solution and four pints of sterile air were injected. No reaccumulation of fluid occurred.

A female child of seven years was the next patient. One pint of fluid was withdrawn from her pleural cavity and one fluidrachm of Adrenalin Chloride Solution and half a pint of sterile air were injected. Though it was highly probable that the pleurisy was tuberculous there was no reaccumulation of fluid and the patient recovered.

CACTINA IN FUNCTIONAL DISEASES OF THE

HEART. *

After referring to all recognized heart stimulants, Dr. Hatch concludes: The last in the list of cardiac stimulants, but by no means the least, is cactina. This drug is the proximate principle of the Cereus Grandiflora (night blooming cereus), and belongs to the natural order of Cactaceæ, a plant indigenous to tropical America. This active principle was most successfully isolated by a pharmaceutical chemist of St. Louis, Frederick W. Sultan, who obtained it from the flowers and stems of the Mexican variety, which yields a greater and more constant quantity than any other species. This drug is non-irritant, and can be applied to the conjunctiva in a ten per cent. solution without producing any noticeable effect. Therapeutic doses cause a rise in the ar

* Abstract from an article in the Medical Examiner and Practitioner, by John L. Hatch, B. S., M. D., New York.

terial pressure and increase in the pulse rate, whereas toxic doses cause first, acceleration of the pulse and a rise in arterial pressure that is followed by a drop in the pressure and a diminution in the rate of the pulse. The pulsations become irregular and spasmodic, and the heart is finally arrested in systole.

A fair conclusion is, that the drug produces these effects chiefly by direct stimulation of the intra-cardiac ganglion.

From this we may summarize that the action of the cactina in therapeutic doses is to increase the musculo-motor energy of the heart, elevate the arterial tension with a corresponding increase in the height and force of the pulse wave, and to elevate the general nervous tone by stimulating the motor centres in the cord.

Cactina is indicated then whenever we need a powerful cardiac tonic stimulant.

Its greatest value has been shown in functional disturbances of the heart, such as simple dilatation and cardio musculo-atony, in which there are no organic lesions.

It has a great advantage over digitalis in that it can be administered continually without producing gastric irritation and without fear from cumulative action.

It is of use also in organic diseases of the heart, save in one instance, viz., mitral stenosis, where digitalis is to be preferred because it prolongs the diastolic period, thus giving the ventricle time and power to empty itself.

The dose of cactina with which the best results have been obtained is 1-100 of a grain (in the form of Cactina Pillets), repeated at frequent intervals. The continued use reduces and regulates the pulse by giving strength and tone to the heart's action.

In several cases of functional disturbances of the heart, particularly tobacco heart, in which I have prescribed cactina, I have been able to reduce the pulse rate within a few hours, and by the withdrawal of the narcotic and continued use of the drug bring the patient to a normal condition.

My experience with cactina has been such that I put more faith in it for functional disturbances than any other remedy that I have tried.

Clinical Reports.

CLINICAL SOCIETY OF THE NEW YORK POLYCLINIC MEDICAL SCHOOL AND HOSPITAL.

STATED MEETING HELD APRIL 4, 1904.

The President, Dr. James Hawley Burtenshaw, in the Chair.

SYPHILIT C PERIOSTITIS.

Dr. W. R. Townsend presented a patient, aged 26 years, with a syphilitic condition of the wrist. Five years ago a diagnosis of tuberculosis of the wrist was made, and a partial excision performed, which resulted in a movable joint. Two years ago a tapering swelling was noticed at the phalangeal joints, attaining its greatest diameter at the articular surfaces. When first seen by the speaker, three weeks ago, he had X-ray photographs of the hand taken, and by this means established the diagnosis of syphilitic periostitis, with joint inflammation. This condition undoubtedly existed when the excision was done for the relief of the supposed tubercular disease. It was an excellent illustration of the value of the X-ray in diagnosis, and especially in differential diagnosis. Radiographs of a tubercular wrist were also shown, in order to bring out clearly the differences between a syphilitic and a tubercular process. The patient has been on antisyphilitic treatment for three weeks, and in that time the pain has decreased, motion had increased, and her feet, which were affected by a similar pathological condition, were much improved, making walking much easier. The speaker also showed a radiograph in which the bones of the ankle were affected by syphilis, and, by way of comparison, one of a foot in which the bone was normal, to illustrate the changes which the bone and surrounding tissues undergo in syphilitic periostitis.

MYOSITIS OSSIFICANS.

This case was also reported by Dr. Townsend. He said that this disease, in which the muscles undergo bony changes, is very